LFA Urges Social Security Commission

LFA Urges Social Security Commission Not to Adopt Proposed 5-Day Rule LFA Believes Proposed Changes Are Too Stringent and Unfair for People with Lupus and Other Chronic Autoimmune Diseases

As part of its mission to provide service, support and hope to all people affected by lupus, the Lupus Foundation of America (LFA) submitted comments on December 28 to Commissioner Michael Astrue of the Social Security Administration (SSA), regarding a proposed change to the rules which could make it more difficult for people appealing a social security determination. The proposed rule would require medical evidence to be submitted 5 days before an administrative hearing. Under the proposed rule, if the medical evidence was not received by the Administrative Law Judge (ALJ) within 5 days of the hearing, applicants could be forced to file new applications to ensure that relevant evidence was considered, rather than continuing the appeals process. This could cause months or years of delays, loss of retroactive benefits, and in some cases result in a complete denial of benefits. The LFA responded with the position that SSA should not adopt the proposed five day rule. Instead, claimants should have the ability to submit medical records as soon as they are obtained, even if that time is after the administrative hearing. The LFA will keep you updated with the final ruling, which may take several months to be determined. Below are the comments LFA submitted to Commissioner Asture. Re: Docket No. SSA-2007-0044 - Proposed Rule Comments Regarding ALJ and Appeals Process Dear Commissioner Astrue, On behalf of the nearly 2 million Americans living with lupus, the Lupus Foundation of America, Inc. (LFA) respectfully submits comments on notice of proposed rule making regarding Amendments to the Administrative Law Judge (ALJ), Appeals Council, and Decision Review Board Appeals Levels (72 Fed. Reg. 612118). Based on providing a fair and equitable process for claimants, the LFA believes that if the proposed regulation is adopted, people with lupus and other chronic autoimmune diseases will be denied benefits because of the complex new procedural requirements established. The symptoms of lupus make diagnosis difficult because they are sporadic and imitate the symptoms of many other illnesses. Lupus is an often fatal and unpredictable disease that can cause inflammation and tissue damage to virtually any organ system in the body, including the skin, joints, other connective tissue, blood and blood vessels, heart, lungs, kidney, and brain. The LFA advocates for a better quality of life for people with lupus and their families who struggle daily with the life-diminishing and life-threatening consequences of the chronic autoimmune disease. Because of the unique and complicated diagnosis of lupus, the LFA is concerned that if the proposed re-opening rules are enacted, individuals will not be allowed to submit medical evidence less than five business days before the administrative hearing. This could very well result in a denial based on an incomplete record. Under the proposed rules, claimants would be forced to file new applications to ensure that relevant evidence is considered, rather than continuing the appeals process. This could cause months or years of delays, loss of retroactive benefits, and in some cases result in a complete denial of benefits. It is the LFA’s position that the proposed changes are too stringent and unfair for people living with lupus and other chronic autoimmune diseases. The five day proposed rule is inconsistent with the realities of obtaining medical records for people living with lupus based on the following reasons: 1. The severity of the diagnosis of lupus may change over time—even a few days can make a difference in the way symptoms present in a person experiencing lupus flares. 2. Since lupus can affect almost every organ system in the body, it often takes multiple visits to numerous specialists to receive an accurate diagnosis. It is not uncommon for a person with lupus to have five or more physicians treating their various affected systems; which undoubtedly leads to a long paper trail of medical history and documents to produce. Therefore, the process of obtaining the needed medical records is often time consuming for both the person with lupus, as well as the physician and/or hospital asked to provide copies of the records with very short notice. 3. People with lupus may have difficulty submitting evidence in a timely manner because they are too ill to devote the time and energy needed to collect the necessary medical records. Unfortunately, many do not have caregivers or family members who are able to assist them in the collection of medical evidence.

In summary, a finite set of medical evidence may not exist for people diagnosed with lupus. It is therefore imperative that claimants have the ability to submit medical records as soon as they are obtained, even if that time is after the administrative hearing. It is important that people with lupus and other chronic autoimmune diseases have greater access to the benefits that they are entitled. The consequences for denial are tremendous-even leading to a loss of eligibility for health coverage under Medicare and Medicaid.

The LFA strongly urges the Social Security Administration to not implement the proposed changes, and to instead carefully consider the individual rights of the millions of people with lupus and other chronic autoimmune diseases who are entitled to due process in seeking benefits under the Social Security Act. Thank you for the opportunity to submit comments, and please feel free to contact me for further questions. Sincerely, Julie A.Venners Vice-President Government Relations Lupus Foundation of America, Inc.